Many newly formed advisors begin entry-level positions as advisors at home and travel to see their clients in homes, schools, community centers, and elsewhere. Trips to the customer can seem strange, especially if the internship experience of the consultant was carried out exclusively in the office. However, according to a 2005 study by D. Russell Crane, Harvey Hillin, and Scott Jakubowski, home counseling has proven to be cost-effective and reduces hospitalization. Therefore there are indications of their usefulness.
Home counseling, sometimes referred to as community counseling, can be effective and beneficial for multiple client groups, including families, older adults, children, and those with developmental disabilities. Mood disorders, anxiety disorders, psychotic disorders, behavior problems and family disorders are typical problems that can benefit from counseling at home. It is often helpful to have a counselor in the home environment to observe mismatched behaviors, relationship problems, and other contextual considerations. After all, counseling at home can be particularly helpful for people who cannot or do not want to come to a counseling office to provide services.
Skill portability is a major benefit of home counseling, which means that it can be useful for those who have difficulty moving skills from one environment to another. For example, a child with intellectual disabilities and behavioral problems may successfully use a calming technique in the counselor's office, but may not be able to do the same at home. Learning and practicing the skills in the home environment with the counselor present to support and support the child increases the likelihood of success. In addition, the counselor can observe the parents or caregivers who ask the child to use the skills and work with them to achieve a consistent implementation. Another example is adults who have been diagnosed with fear and who have difficulty using effective coping skills in triggering situations. At home, the counselor can ask the person to identify the triggers before the fear begins and promote coping skills.
Home counseling offers the counselor an enriched perspective of the client and the context of the presenting topics. Family or environmental issues can be assessed using examples and observations in the here and now, which often leads to a more immediate feedback process. For example, family members may show "best behavior" in the counselor's office, or a single family member may refuse to participate in a problem. By conducting counseling at home, the counselor can directly observe these behaviors and use them immediately to point them out, and then jointly identify appropriate behaviors.
In combination with behavioral indicators, the physical environment and the level of cleanliness of the house can provide the advisor with important information regarding the situation of the client. For example, a client who cannot pay her rent, has little food for her family, and has broken floorboards in the kitchen may not have the same focus or motivation as a client in a more stable life.
Finally, clients can "not show" or cancel the consultation sessions in the office for various reasons. Examples include the recent loss of transportation or jobs, parental leave for a new baby, medical or health problems that warrant bed rest, severe and restrictive psychiatric symptoms, etc. Home counseling provides an opportunity to meet clients where they are and what they can contribute to the relationship.
For example, patients who have been diagnosed with a psychotic disorder may experience symptoms such as paranoia that prevent them from coming to the office for treatment or other activities such as grocery shopping. A home advisor could work with such a person in their home to help them identify their feeling of paranoia and learn how to use reality testing techniques to reduce paranoia.
Although home counseling offers many benefits, ethical and security concerns can prevent professional advisors from offering this service. In addition, the possibility of consultant burnout is a factor that must be considered when evaluating this type of format for meetings.
Ethical concerns
Consultants need to act ethically when offering advice to their clients. Confidentiality, border problems and access to supervision are among the ethical concerns that advisors are likely to encounter when providing home advisory services.
Confidentiality
One of the most important ethical duties of consultants is to keep their clients confidential. However, it is difficult to maintain or provide confidentiality in home environments where the structure and consistency of office settings are absent. When entering a customer's home, the advisor cannot be sure who lives in or visits the home during the session. A roommate could go through the front door, or a sibling could refuse to leave the common room – both of which could jeopardize the progress and process of counseling. Confidentiality cannot be guaranteed if more than one person attends the session. Maintaining confidentiality can be particularly difficult when the home is small or when there is insufficient and secure space for a private session.
When advising children and families, the confidentiality requirements change. Children do not have the right to their own confidentiality; This belongs to the parent or legal guardian. Consultants explain the limits of confidentiality to both parents and the child. In the office, the counselor can suggest that parents wait in the waiting room during the session to give the child a sense of privacy or confidentiality. In a home environment, convincing parents to leave the room during the session can be more difficult. The parent can insist that the parent has the right to be wherever he wants because the counselor is at home. In such situations, it can be more difficult to communicate how important it is to give the child some privacy.
boundaries
Consultants learn to respect the boundaries of the counseling relationship and consider how bending these boundaries can affect the counseling relationship. Typically, consultants do not interact with their clients outside of counseling sessions. Setting these limits is much easier if there is an office space specifically designed for advice and if time constraints need to be met (e.g., stay at work during a meeting because the next customer is already on his appointment has appeared). At a customer's home, however, the boundaries can blur. Both the client and the advisor could struggle with time and space limits.
There are several ways that customers can blur the boundaries in their homes that are different from those that typically occur in an office environment. For example, the customer may be inclined to provide food and drink as if they were entertaining a guest. This enables the advisor to decide whether to accept and what messages this decision can send. Acceptance can set a precedent that the client must “maintain” at each session. The client may also feel that they need to clean their home or otherwise change their environment to impress the advisor. If the client shows a show, it can affect the authenticity of the counseling relationship.
Consultants can blur the boundaries by feeling so comfortable in the client's home that they begin to treat the relationship as friendship or become distracted by the environment. In a relaxed environment, it can be easy to spend too much time checking in and chatting, rather than focusing on doing the necessary work on customer issues. This can be the case in particular if the location of the advice at home changes from session to session.
supervision
Most counselors must undergo weekly supervision while collecting hours for their license to practice independently. However, access to this manager can be difficult if the advisors are not in the hallway of or in the same building as their manager. This can lead consultants to make decisions without seeking supervision or advice on important issues if they should.
For example, a counselor might examine a client for suicidal thoughts, but be unsure of the results. Instead of contacting the manager, the advisor can choose to trust his or her own judgment. This could lead to an incorrect evaluation and intervention plan. It can also be difficult for the supervisor to monitor the services provided or to evaluate the supervisor if the supervisor is not located in the same place. The feedback process is only changed by proximity and immediacy in the home environment. This can have ethical implications that differ from those in the office environment.
Security Concerns
In addition to ethical concerns, the safety of clients and consultants should be considered. A client's home can be an unpredictable environment with security concerns for the advisor. These can be security concerns related to pets, physical barriers, the customer's neighborhood, other people associated with the customer, etc. For example, the advisor may be allergic to the customer's pets, or a pet may not be happy to have a stranger at home and become aggressive. Conversely, the pet can be overly friendly. If the advisor is unfamiliar with the pet's behavior, the pet may misunderstand the advisor's actions and become aggressive. These interactions with the pet can make it unsustainable for the counselor to continue offering home services to the client.
Advisors must also be aware of those in the household who may raise safety concerns. An example is when a customer's partner is unhappy that the customer is looking for help. The significant other can be intimidating or aggressive towards the counselor to prevent the client from receiving services.
Customers themselves could be a threat to the advisor. If the client has shown aggressive behavior in the past, the counselor may consider seeing the client in an office or referring them to an adviser in the office.
Consultants may also have customer security issues. For example, a client might express thoughts of murder or suicide. Even if the client does not threaten the advisor, intervention may be required to protect the client or others. In such circumstances, a newer advisor may need to contact a supervisor or more experienced advisor immediately to gain access to more intensive interventions. If the advisor does not have direct access to their manager, they may not be able to intervene appropriately. In the agencies where we worked, we were encouraged to have contact information for our superiors and an experienced advisor that is easily accessible on our cell phones and computers.
Burnout
Taking ethical and safety concerns into account while trying to help clients make positive changes can result in stress and burnout for home consultants. The American psychologist Herbert Freudenberger first coined the term burnout in the 1970s to describe the consequences of severe stress in connection with the helping professions.
Burnout consists of three components: 1) loss of empathy, 2) reduced sense of achievement and 3) feeling of emotional exhaustion. Frequent experiences with burnout can include sleep disorders, blurred boundaries, feelings of relief when a client is delayed or canceled, and even the realization that one is not careful when speaking to the client. It's not uncommon for professional counselors to experience burnout at some point in their careers, but home counselors are often more likely to suffer from these negative symptoms than their office colleagues. Three possible reasons for this phenomenon are the physical requirements of travel, the consequences of constantly dealing with difficult customer problems and the reality of a professional isolation company.
First, consultants move around at home all day. The feeling of being established and organized flies out of the window when the trunk is filled with therapeutic toys and the storage system for customer worksheets in the back seat of the car has toppled over. Home consultants put their entire office on the street. This can lead to challenges in terms of space use, degree of organization and the impairment of private life – especially for consultants who have to use their own cars at work.
In addition to these challenges, home counselors must face the weather conditions and general wear and tear of travel. Traffic, construction, road and car problems are persistent and uncontrollable stress factors for consultants working on site. I remember a colleague who hated going to her son's soccer games on weekends because she was so frustrated having to drive to work all week. Tired of the physical demands of lugging her laptop and resources around, she was discouraged from repeatedly having to pay for car repairs. These external sources of stress piled up and eventually led them to look for another position. Although the trip to a home position can provide variety, flexibility, and stimulation to the counselors, too much of all of these things can lead to burnout.
Home consultants can also be affected by burnout because they encounter more intense customer problems on site. Generally, customers look for services at home due to a lack of resources, systemic problems, family / relational problems, or simultaneous diagnoses. These cases are typically more tedious, time-consuming, and complex than cases for an average office customer. This could be due to the amount of phone calls, interdisciplinary meetings, paperwork, crisis management and case management associated with the all-round approach.
Because consultants travel from place to place at home during their working days, they don't necessarily get the downtime to work, reflect, or consult with other consultants and supervisors who might offer a supportive ear. As a result, compassion fatigue can set in and lead to burnout among consultants.
In addition, the advisors at home often lack the structure of a fixed schedule. Depending on the course of the day, they may have to complete the documentation at home or after hours. The likelihood of a burnout increases when the boundaries blur, the time "on" and the time "off" are not different and there is little to no time to deal with customer problems.
Finally, the daily work of consultants at home can be perceived as isolating or lonely. Although there is interaction and stimulation with many other people throughout the day, home counselors often lack professional support and the ability to work with colleagues after meetings. There is also less time for immediate customer monitoring and advice, mainly because you need to pack and get to your next home. Details are lost and the consultant at home has less time to process and design them. All of this leads to a faster burnout than normal.
Tips for Success
At this point, we know that the work of consultants at home can be physically and emotionally challenging, although it can also be very rewarding and customer-centric. In order to counter the effects of burnout, various tips and strategies can be implemented to treat these consultants more comprehensively, to increase employee satisfaction and to improve customer results.
To meet the physical requirements of the position, advisors at home should carefully consider their schedules and level of organization. It can be invaluable to take time every week to plan, pack and create structures. For example, instead of going from zip code to zip code, consultants should set their schedules based on mileage or display of all customers from an area on a given day, if possible. Meetings and supervision can be scheduled for a day of the week that coincides with office filing times when the advisor has access to a printer and other resources. "Work smarter, not harder" was a popular buzzword in our agencies when we offered home advisory services.
In addition, regulators should have access to and consider the number of cases and schedules of counselors at home. Travel time, weather conditions and the possibility of a session being extended due to a crisis should be considered every day. On particularly hot days, Allison's supervisor had popsicles and cold mineral water available for weekly team meetings. This was a small gesture, but the advisors felt they were in good hands given the special requirements of their work.
When dealing with security challenges, advisors at home should be prepared, careful, and careful with their surroundings. One way to prepare is to hold the first meeting with the customer in an office environment. The advisor can use this first meeting to assess whether the customer is suitable for home services. If the client shares that they have, for example, a partner or a pet that has been aggressive in the past, the counselor can decide to refer to counseling in the office. If the client determines that he has a pet that the counselor is allergic to, he can contact another counselor at home who is not allergic. It is also recommended to set a start and end time for home services.
Once in the community, precautions could be to have a basic food and hygiene kit in the car in an emergency. Wearing a proper ID, charging the phone, and wearing appropriate clothes and shoes are easy steps to keep some level of control. Sometimes it is advisable to avoid certain streets or areas to reduce the risk of injury or crime. Consultants can position themselves near the door of the house or apartment if they fear that their client or someone else in the house could become aggressive. Consultants may also want to be alert to things that excited clients or others around the house might use as weapons. Instead of meeting the client in a home environment that the counselor fears may be unsafe, the counselor could encourage the client to meet in a community center or other less isolated location. In addition, it offers advantages to find out about the resources available in the customer community and to network with other local agencies about opportunities and support.
Using a team-based approach is a way to increase support for counselors at home while reducing the feeling of loneliness they sometimes experience. Weekly team meetings at changing locations, group text messages, daily "check-ins" for consultants by email or phone, quarterly retreats and employee appreciation / celebrations are other examples of deliberate ways that superiors can provide a level of protection and support for them Can create at home -based consultants. A team-based approach can also help address ethical concerns that can arise when consultants are on site.
Finally, personal well-being and a SMART-based (specific, measurable, achievable, realistic / relevant, time-limited) self-care plan are essential for the success and sustainability of consultants at home. It is important to intentionally schedule the schedule to allow time for paperwork and training to reduce the amount of work that goes out of time in the clock.
Home counselors should differentiate as much as possible between their working and non-working self – not only for themselves, but also for their colleagues and relatives. For example, one of the authors of this article would use the drive home from their last session to mentally process the day so that they can "leave" their work in the car. It is also important to stay physically active and make room for rest. Home counselors should also be sure to stay in touch with others through consultation, supervision and collaboration. Personal advice as a form of self-confidence and health maintenance can also be helpful.
Home counseling can be a daunting experience for inexperienced counselors, but it can also be a rewarding and enriching experience for both them and their clients. Proper customer assessment and ensuring adequacy for home visits is the first step to a productive working relationship. Understanding the various aspects of the position, including how to be strategic and keep within reasonable boundaries, is also critical for the home advisor. It is also important to conduct regular ethics and security reviews and allow enough time for paperwork, monitoring and collaboration every week. Any of these strategies can help consultants succeed on some of the most difficult local customer issues. Those who oversee counselors at home should focus on a team-based approach to prevent isolation and burnout from these counselors.
Ultimately, home counseling is a challenging job, although it is also useful and often very productive. We encourage you to think about it when looking for your next job.
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Robin M. DuFresne is an assistant professor and program coordinator for clinical mental health and school counseling programs at Bowling Green State University in Ohio. She has worked in various areas of mental health in the community. Contact them at [email protected].
Allison K. Arnekrans is an associate professor, faculty advisor for the Chi Sigma Iota Mu Kappa chapter and coordinator for internships and internships at Central Michigan University. By profession, she is a counselor for children and adolescents with experience in the area of mental health in the community, partial hospitalization and attitudes for employee assistance programs. Contact them at [email protected].
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Knowledge sharing articles were developed from sessions presented at American Counseling Association conferences.
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